Tamayo, Teanu Jose G.
BSN-III-C2
January 15, 2018
NCM 104
Assg. #3
Advances in Perioperative Nursing:
The first landmark
Advancement in monitoring technology occurred in
1980’s with the advent of pulse oximetry in clinical
practice. A significant Cochrane review highlighted
data from four trials including 21,000 patients and
confirmed that pulse oximetry could detect
hypoxaemia and related events, but there was little
evidence that it affects the perioperative mortality
and morbidity.
The use of metrics and surveillance methods
in assessing surgery on a global scale have since
played a key role in evaluating health system
performance. This followed the publication of 6
metrics for surgical surveillance by the WHO in
2009.23 In current practice, the anaesthesia related
to elective caesarean section is now 30 times safer
than it was in the 1960s.
The continuous monitoring of ASA
recommended minimal monitors are a must in
the intraoperative period.
Recently updated “American Heart Association-
American College of Cardiology 2007 guidelines on
perioperative cardiovascular evaluation and care for
noncardiac surgery includes a level 1
recommendation for maintenance of perioperative
normothermia in patients undergoing surgical or
therapeutic procedures under general or regional
anesthesia exceeding 60 min by use of active
warming measures or by achievement of target
temperature of 26°C in the operating room and the
postanesthesia care unit.
1
Neurological monitoring
Intracranial pressure monitoring continues to be an
essential monitor in neurosurgery.
Jugular venous oximetry (SjO2) is considered to be
an integral part of the neurological monitoring as it
gives information on the adequacy of cerebral blood
flow in relation to the metabolic demand of the
brain. SjO2 monitoring is highly sensitive in the
presence of global hypoxemia or ischemia, but the
shortcoming is the inability to detect focal ischemia.
Despite the many limitations of the method and the
lack of grade 1 evidence, interest is still being
focused on SjO2 monitoring. Brain tissue oxygen
partial pressure (PbO2) has emerged as a reliable
monitor of cerebral oxygenation more so during the
course of interventions such as CPP manipulations
and hyperventilation. The invasiveness of the PbO2
monitor has limited its usefulness, but combining
parameters such as ICP and PbO 2 into a single
probe have now reduced the number of probes
inserted.
Alarms and cognition
Alarms are the integral part of the anesthesia
monitor and being used in many clinical
applications. Increased attention to safety and
numbers of medical litigation following an adverse
event in anesthesia practice has led to the
widespread use of alarm system.
Technological advancement in perioperative pain
assessment
Inadequate postoperative pain management may
have many undesirable effects like increased
hospital stay, impaired quality of life, development
of chronic pain and increased morbidity and
mortality. Postoperative pain management is one of
the most challenging factors for determining patient
outcome following surgery. Thus, regular and
comprehensive pain assessment in the perioperative Fowler, A. J. (2013). A Review of Recent Advances
period would help in improving the postoperative in Perioperative Patient Safety. Annals of
acute pain management. There are various scales Medicine and Surgery, 2(1), 10-14.
and questionnaires for subjective pain assessment doi:10.1016/s2049-0801(13)70020-7
tools and are categorized into uni-dimensional
(numerical rating scale, visual analogue scale, faces Sweeney, P. (2010). The Effects of Information
pain scale) Technology on Perioperative Nursing. AORN
Journal, 92(5), 528-543.
and multidimensional (neuropathic pain assessment doi:10.1016/j.aorn.2010.02.016
NPS, McGill’s pain questionnaire. The
technological advancement in the objective
assessment of pain has occurred recently with the
introduction of pain assessment monitors like
algesimetry and surgical pleth index (SPI).
Algesimeter is a device used to detect the sensitivity
of the skin to a painful stimulus and is faster and
more sensitive and specific when compared to other
objective pain assessment methods.

To conclude, new and improved monitoring

techniques have undoubtedly led to dramatic
changes in anesthesia practice. Various factors that
need to be considered with the use of improved
monitoring techniques are the validation data,
patient outcome, safety profile, cost effectiveness,
awareness of the possible adverse events,
knowledge of technical principle and ability of the
convenient routine handling. So far, there is a lack
of substantial evidence if these new improved
monitoring techniques have improved patient
outcome. How often these improved monitors are
used for a particular indication also varies from
institution to institution.

REFERENCE

Chilkoti, G., Wadhwa, R., & Saxena, A. (2015).

Technological advances in perioperative
monitoring: Current concepts and clinical
perspectives. Journal of Anaesthesiology
Clinical Pharmacology, 31(1), 14.
doi:10.4103/0970-9185.150521